scholarly journals DISTAL ARTERIOVENOUS FISTULAS IN THE TREATMENT OF CHRONIC CRITICAL LOWER LIMB ISCHEMIA

2021 ◽  
pp. 106-111
Author(s):  
V. I. Rusin ◽  
P. A. Boldizhar ◽  
V. V. Rusin ◽  
F. V. Gorlenko ◽  
M. M. Lopit
Keyword(s):  
Lower Extremities ◽  
Posterior Tibial Artery ◽  
Arterial Blood Flow ◽  
Anterior Tibial Artery ◽  
Critical Ischemia ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Results Of Treatment ◽  
Anterior Tibial ◽  
Grade Iii

Summary. The aim of the study. To study the effectiveness of the proposed surgical methods in the treatment of critical ischemia of the lower extremities. Materials and methods. In our work the analysis of results of treatment of 36 patients with chronic critical ischemia of the lower extremities who were on treatment in ZOKL of them is presented. Andriy Novak. Grade III A ischemia was diagnosed in 11 patients, grade III B — in 15, grade IV — in 10 patients and studied the microcirculation of the lower extremities in 31 people without pathology of the cardiovascular system, taking into account the angiosomal approach. We found that the highest rates of perfusion units on the thigh were found in the basin of the sciatic and posterior arteries, the lowest — in the basin of the deep femoral artery and popliteal artery. On the shin, the highest rates of microcirculation were found in the basin of the posterior tibial artery, the lowest - on the foot. Results and discussion. The level of regional perfusion of the corresponding angiosomes of the skin of the lower extremities after anastomosis between the anterior tibial artery and anterior tibial vein showed that the improvement of microcirculation is observed in those angiosomes whose blood supply is provided by the anterior tibial artery and its artery and artery. When creating anastomoses between the posterior tibial artery and the posterior tibial vein, the microcirculation in the skin increased 3-5 times compared to baseline and its level was 70 % of normal in those angiosomes, which supply blood to the posterior tibial artery and its continuation on the foot. At the same time, there is an increase in skin microcirculation in the angiosome of the tibial artery, which is apparently due to the presence of a relatively large number of first-type anastomoses in the triceps. In our opinion, any of the proposed treatments should begin before the development of critical ischemia. Conclusions. The dependence of skin perfusion on the main arterial blood flow is proved taking into account the angiosomal theory, which allows to use this method in the diagnosis and evaluation of the results of treatment of chronic critical ischemia of the lower extremities. Microcirculation of the skin of the lower leg and foot improves 3.5–5 times 30 days after the creation of arteriovenous fistula below the occlusion of the anterior tibial artery and posterior tibial artery in chronic critical ischemia of the lower extremities.

scholarly journals Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

2021 ◽  
Vol 88 (3-4) ◽  
pp. 28-34
Author(s):  
M. M. Lopit ◽  
V. І. Rusyn ◽  
P. A. Boldizhar ◽  
F. V. Gorlenko ◽  
O. M. Kochmar
Keyword(s):  
Surgical Treatment ◽  
Lower Extremities ◽  
Late Results ◽  
Anterior Tibial Artery ◽  
Critical Ischemia ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Arteries ◽  
Anterior Tibial ◽  
Indirect Revascularization

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice. Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment. Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients. Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients. Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

scholarly journals Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

2016 ◽  
Vol 18 (1) ◽  
pp. 64 ◽  
Author(s):  
Miao Zheng ◽  
Chuang Chen ◽  
Qianyi Qiu ◽  
Changjun Wu
Keyword(s):  
Anatomical Variation ◽  
Posterior Tibial Artery ◽  
Peroneal Artery ◽  
Medial Malleolus ◽  
Anterior Tibial Artery ◽  
Tarsal Tunnel ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Arteries ◽  
Anterior Tibial

Aims: Knowledge about branching pattern of the popliteal artery is very important in any clinical settings involving the anterior and posterior tibial arteries. This study aims to elucidate the anatomical variation patterns and common types of anterior tibial artery (ATA) and posterior tibial arteries (PTA) in the general population in China. Material and methods: Anatomical variations of ATA, PTA, and peroneal artery were evaluated with ultrasound in a total of 942 lower extremity arteries in 471 patients. Results: Three patterns of course in the PTA were ultrasonographically identified:  1) PTA1: normal anatomy with posterior tibial artery entering tarsal tunnel to perfuse the foot (91.5%),  2) PTA2: tibial artery agenetic, and replaced by communicating branches of peroneal artery entering tarsal tunnel above the medial malleolus to perfuse the foot (5.9%), and 3) PTA3: hypoplastic or aplastic posterior tibial artery communicating above the medial malleolus with thick branches of peroneal artery to form a common trunk entering into the tarsal tunnel (2.4%). In cases where ATA  was hypoplastic or aplastic, thick branches of the peroneal artery replaced the anterior tibial artery to give rise to dorsalis pedis artery, with a total incidence of 3.2 % in patients, and were observed more commonly in females than in males. Hypoplastic or aplastic termini of ATA and PTA, with perfusion of the foot solely by the peroneal artery, was identified in 1 case. In another case, both communicating branches of the peroneal artery and PTA entered the tarsal tunnel to form lateral and medial plantar arteries.Conclusions: Anatomical variation of ATA and PTA is relatively common in the normal population. Caution should be exercised with these variations when preparing a peroneal artery vascular pedicle flap grafting. Ultrasound evaluation provides accurate and reliable information on the variations.

scholarly journals Effects of Enhanced External Counterpulsation With Different Sequential Levels on Lower Extremity Hemodynamics

2021 ◽  
Vol 8 ◽  
Author(s):  
Yahui Zhang ◽  
Yujia Zhang ◽  
Yinfen Wang ◽  
Xiuli Xu ◽  
Jing Jin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Posterior Tibial Artery ◽  
Anterior Tibial Artery ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Dorsalis Pedis Artery ◽  
Level Sequence ◽  
Anterior Tibial ◽  
Enhanced External Counterpulsation

Objective: This study aimed to investigate acute hemodynamics of lower extremities during enhanced external counterpulsation with a three-level sequence at the hips, thighs, and calves (EECP-3), two-level sequence at the hips and thighs (EECP-2), and single leg three-level sequence (EECP-1).Methods: Twenty healthy volunteers were recruited in this study to receive a 45-min EECP intervention. Blood flow spectrums in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery were imaged by Color Doppler ultrasound. Mean flow rate (FR), area, pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and systolic maximum acceleration (CCAs) were sequentially measured and calculated at baseline during EECP-3, EECP-1, and EECP-2.Results: During EECP-3, PI, PSV, and MV in the anterior tibial artery were significantly higher, while EDV was markedly lower during EECP-1, EECP-2, and baseline (all P < 0.05). Additionally, ACCs were significantly elevated during EECP-3 compared with baseline. Moreover, FR in the anterior tibial artery was significantly increased during EECP-3 compared with baseline (P = 0.048). During EECP-2, PI and MV in the dorsalis pedis artery were significantly higher and lower than those at baseline, (both P < 0.05). In addition, FR was markedly reduced during EECP-2 compared with baseline (P = 0.028). During EECP-1, the area was significantly lower, while EDV was markedly higher in the posterior tibial artery than during EECP-1, EECP-2, and baseline (all P < 0.05). Meanwhile, FR of the posterior tibial artery was significantly reduced compared with baseline (P = 0.014).Conclusion: Enhanced external counterpulsation with three-level sequence (EECP-3), EECP-2, and EECP-1 induced different hemodynamic responses in the anterior tibial artery, dorsalis pedis artery, and posterior tibial artery, respectively. EECP-3 acutely improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery. In addition, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduced blood flow in the posterior tibial artery.

scholarly journals Pseudoaneurysm of the Perforating Peroneal Artery following Ankle Arthroscopy

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Ichiro Tonogai ◽  
Eiki Fujimoto ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Vascular Complications ◽  
Posterior Tibial Artery ◽  
Ankle Arthroscopy ◽  
Peroneal Artery ◽  
Anterior Tibial Artery ◽  
Foot And Ankle ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Anterior Tibial

The use of standard anterolateral and anteromedial portals in ankle arthroscopy results in reduced risk of vascular complications. Anatomical variations of the arterial network of the foot and ankle might render the vessels more susceptible to injury during procedures involving the anterior ankle joint. The literature, to our knowledge, reports only one case of a pseudoaneurysm involving the peroneal artery after ankle arthroscopy. Here, we report the unusual case of a 48-year-old man in general good health with the absence of the anterior tibial artery and posterior tibial artery. The patient presented with a pseudoaneurysm of the perforating peroneal artery following ankle arthroscopy for traumatic osteoarthritis associated with nonunion of the medial malleolus. The perforating peroneal artery injury was repaired by performing end-to-end anastomosis. The perforating peroneal artery is at higher risk for iatrogenic injury during ankle arthroscopy in the presence of abnormal arterial variations of the foot and ankle, particularly the absence of the anterior tibial artery and posterior tibial artery. Before ankle arthroscopy, surgeons should therefore carefully observe the course of the perforating peroneal artery on enhanced 3-dimensional computed tomography, especially in patients with a history of trauma to the ankle joint.

Quantitative and Qualitative Assessment of the Relative Arterial Contributions to the Calcaneus

2018 ◽  
Vol 39 (5) ◽  
pp. 604-612 ◽  
Author(s):  
Johanna C. E. Donders ◽  
Craig E. Klinger ◽  
Andre D. Shaffer ◽  
Lionel E. Lazaro ◽  
Ryan R. Thacher ◽  
...  
Keyword(s):  
Posterior Tibial Artery ◽  
Quantitative Mri ◽  
Peroneal Artery ◽  
Anterior Tibial Artery ◽  
Soft Tissue Envelope ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Contrast Enhanced ◽  
Entry Points ◽  
Anterior Tibial

Background: The purpose of this study was to quantitatively and qualitatively assess relative arterial contributions to the calcaneus. Method: Fourteen cadaveric ankle pairs were used. In each specimen, the posterior tibial artery, peroneal artery, and anterior tibial artery were cannulated and used for contrast-enhanced magnetic resonance imaging (MRI) and computed tomography (CT). Quantitative MRI analysis of the pre- and postcontrast MRI scans facilitated assessment of relative arterial contributions. In addition, postcontrast MRIs were used to measure all perfused arterial entry points and scaled to a 3-dimensional calcaneus model. Contrast-enhanced CT imaging was assessed to further delineate the extraosseous arterial course. Two pairs underwent infusion of diluted BaSO4 through a constant-pressure pump using extended infusion duration. Results: Quantitative MRI findings indicated the peroneal artery provided 52.6% of the calcaneal arterial supply, 31.6% from the posterior tibial artery, and 15.8% from the anterior tibial artery. The cortical entry points were found in fairly consistent patterns along calcaneal cortical surfaces. All specimens demonstrated intraosseous anastomoses between lateral and medial entry points at common locations. Conclusions: The peroneal artery was found to provide the largest calcaneal arterial contribution, followed by the posterior tibial artery and anterior tibial artery. A rich anastomotic arterial network was found supplying the calcaneus. Clinical Relevance: This study provides quantitative and qualitative findings of the relative arterial contribution of the calcaneus. This knowledge can help expand our understanding of calcaneal vascularization, demonstrate the vascular impact of calcaneal fracture and surgery, and facilitate future research on the arterial anatomy of the calcaneal soft tissue envelope.

Collateral circulation between angiosomes in the feet of diabetic patients

Vascular ◽  
2018 ◽  
Vol 26 (4) ◽  
pp. 432-439 ◽  
Author(s):  
Erkan Orhan ◽  
Ömer Özçağlayan
Keyword(s):  
Collateral Circulation ◽  
Posterior Tibial Artery ◽  
Artery Occlusion ◽  
Peroneal Artery ◽  
Diabetic Patients ◽  
Anterior Tibial Artery ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Tibial Artery Occlusion

Objectives The main factor in the healing of foot ulcers in diabetic patients is adequate perfusion. There is no consensus on whether direct or indirect revascularization is more effective in leg revascularization. At the centre of that debate, there is a disagreement about whether collateral circulation is sufficient or not. Our aim is to evaluate collateral circulation activity between angiosomes in the feet of diabetic patients by evaluating the level of occlusion in leg arteries and comparing the angiosome regions that have necrosis. Methods The study included 61 patients. All had undergone CT angiography to the lower extremity prior to any revascularization of the leg arteries between September 2014 and September 2016. Stenosis was evaluated on the anterior tibial artery, the posterior tibial artery and the peroneal artery up to the level of the ankle. The opening of the vessel wall at the narrowest part of the vessel was determined as a percentage. The areas with necrosis were determined according to the angiosomes of the posterior tibial artery, anterior tibial artery and peroneal artery vessels. Results Necrosis of the foot was most common in the posterior tibial artery angiosome. Necrosis in the posterior tibial artery angiosome was independent of the level of posterior tibial artery occlusion; however, it was associated with the occlusion of the anterior tibial artery ( p < 0.05). It was found that anterior tibial artery occlusion over 15% resulted in necrosis in the posterior tibial artery angiosome. Conclusions Collateral circulation between the anterior tibial artery and posterior tibial artery is active and there is almost always occlusion in the posterior tibial artery branches. The posterior tibial artery angiosome is fed by the collateral arteries of the anterior tibial artery even if there is no occlusion of posterior tibial artery at the level of the leg, so indirect revascularization on the anterior tibial artery is sufficient to provide foot circulation.

scholarly journals Anomalous origin of posterior tibial artery from anterior tibial artery: beware!

2017 ◽  
Vol 4 (4) ◽  
pp. 1461
Author(s):  
Abheesh Varma Hegde ◽  
Ann Sunny ◽  
Sunil Joshi
Keyword(s):  
Bypass Graft ◽  
Surgical Flaps ◽  
Posterior Tibial Artery ◽  
Anomalous Origin ◽  
Anterior Tibial Artery ◽  
Tibial Osteotomy ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
The Right

A 64 year old diabetic, hypertensive male with claudication and rest pain in his left leg was found to have diffuse narrowing below the politeal artery in the left lower limb with good collaterals. There was bifurcation of the right popliteal artery above the knee joint and an anomalous origin of the right posterior tibial artery from the anterior tibial artery. Awareness of anotomical variations is important for evaluation of the lower extremity arteriograms, for vascular surgeons during reconstructions such as femorodistal bypass graft procedures and embolectomy, during surgical techniques such as arthroscopy, tibial osteotomy, vascular reconstruction grafts, plastic surgical flaps and catheterization procedures.

scholarly journals The Effect of Muscle Exercise on Perforators Flow: A Prospective Cohort Study

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 338
Author(s):  
Francesco Amendola ◽  
Luca Vaienti ◽  
Giuseppe Cottone ◽  
Giovanna Zaccaria ◽  
Zvi Steinberger ◽  
...  
Keyword(s):  
Blood Flow ◽  
Muscle Blood Flow ◽  
Arterial Blood Flow ◽  
Anterior Tibial Artery ◽  
Healthy Population ◽  
Tibial Artery ◽  
Arterial Blood ◽  
Anterior Tibial ◽  
Basal Flow ◽  
Flow Velocities

Background and objectives: The metabolic response after exercise causes a significant increase in the muscle blood flow. While these effects are demonstrated for intra-muscular vessels, there is no evidence about the inter-muscular vessels, such as the septocutaneous perforators supplying the skin after they branch out from the deep source artery. The aim of our prospective study was to quantify the changes in the anterior tibial artery perforators arterial blood flow after mild isotonic exercise in a young and healthy population. Material and Methods: We performed a prospective analysis of 34 patients who were admitted to the Plastic Surgery Department from December 2019 to April 2020. Flow velocities of two previously identified anterior tibial artery perforators were recorded both before and after 10 complete flexion-extensions of the foot. The time to revert to basal flow was measured. We further classified the overmentioned patients based on their level of physical activity. Results: We registered a significant increase in systolic, diastolic and mean blood flow velocities both in proximal and distal anterior tibial artery perforators after exercise. Fitter patients exhibited a higher increase in proximal leg perforators than those who did less than three aerobic workouts a week. The time to return to basal flow ranged from 60 to 90 s. Conclusions: This was the first study to describe the effect of muscular activity on perforators blood flow. Even mild exercise significantly increases the perforator flow. Waiting at least two minutes at rest before performing the Doppler study, thus avoiding involved muscle activation, can notably improve the reliability of the pre-operative planning.

scholarly journals Anatomical and clinical evaluation of perforator-based flaps of lower limb

2019 ◽  
Vol 6 (2) ◽  
pp. 381
Author(s):  
Mohit Jain ◽  
R. K. Basant ◽  
Shivam Madeshiya ◽  
D. Kumar ◽  
Vikas Dwivedi ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lower Leg ◽  
Posterior Tibial Artery ◽  
Peroneal Artery ◽  
Anterior Tibial Artery ◽  
Medical College ◽  
Tibial Artery ◽  
Anatomical Basis ◽  
Anterior Tibial ◽  
Post Traumatic

Background: Wound of lower leg have a poor and delayed healing due to paucity of blood supply. Coverage of defects of leg and foot has always posed a problem for reconstructive surgeon. The objective of this study was to evaluate anatomical basis of various perforator-based flaps in lower limb and their clinical outcome and usefulness.Methods: All patients with post traumatic defects with exposed bones/tendons in the leg and ankle region presenting in MLN Medical college, Allahabad from August 2011 to July 2012 were included in the study.Results: A total 12 patients were included in study. Majority of cases are of compound fracture following accidents involving lower one third of leg. Majority of flaps were based on peroneal artery (5) and posterior tibial artery (5), only 2 flaps were based on anterior tibial artery. Maximum flap length was 21cm and maximum flap rotation was 180º. Complications occurred more in cases having maximum rotation. Result were good in 11 patients and satisfactory in 1 patient with coverage of the defect leading to healing of the wound. More time gap between injury and flap reconstruction leads to more complications and longer hospital stay. Graft site complication occur in 5 cases include partial flap necrosis, infection and venous congestion. There was no complication at the donor site.Conclusions: Perforator based flaps can be used for all large lower leg defects provided there is correct measurement and anatomical knowledge of various perforators, with good functional and cosmetic results.

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